Provider Demographics
NPI:1851607725
Name:GRIGG, REBEKAH (PHARMD)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:
Last Name:GRIGG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:REBEKAH
Other - Middle Name:
Other - Last Name:BJORKMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5148 W BAINBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83703-3418
Mailing Address - Country:US
Mailing Address - Phone:208-369-0260
Mailing Address - Fax:208-321-9241
Practice Address - Street 1:1520 N COLE RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8563
Practice Address - Country:US
Practice Address - Phone:208-375-8278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-29
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP6184183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist